IAM Treasurer Price: Free First Name: First Name Required Last Name: Last Name Required Address Line 1:* Address Line 1 is Required Address Line 2: Address Line 2 is not valid City:* City is Required Country:* Country is Required -- Select Country -- United States (US) Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe State/Province:* State/Province is Required Zip/Postal Code:* Zip/Postal Code is Required Phone:* Phone is Required Company: Company is not valid Title: Title is not valid Website: Website is not valid Atty # / Mediator #: Atty # / Mediator # is not valid Please list the schools of higher education from which you've graduated, along with years of attendance and degree:* Please list the schools of higher education from which you've graduated, along with years of attendance and degree is Required How many hours of mediation training have you received?:* How many hours of mediation training have you received? is Required Less Than 50 50 - 75 Hours 75 - 100 Hours More than 100 hours List the mediation courses you've completed and indicated whether or not they've been certified by the ICCLE Commission. If you checked 'More than 100 hours' above, simply enter 'More than 100 hours' below.:* List the mediation courses you've completed and indicated whether or not they've been certified by the ICCLE Commission. If you checked 'More than 100 hours' above, simply enter 'More than 100 hours' below. is Required Your Profession (Lawyer, Mental Health Professional, Social Worker, etc.):* Your Profession (Lawyer, Mental Health Professional, Social Worker, etc.) is Required Attorney # / Indiana Registry Mediator #: Attorney # / Indiana Registry Mediator # is not valid I accept mediation cases in the following categories:* I accept mediation cases in the following categories is Required Civil Mediation Domestic Mediation Reconciliation Other (As Described in Profile) Description of your practice and experience for your profile: Description of your practice and experience for your profile is not valid I serve Northwest Indiana I serve the South Bend / Elkhart area I serve the Fort Wayne area I serve the Kokomo / Logansport area I serve the Lafayette area I serve the Indianapolis metro area I serve the Muncie / Richmond area I serve the Columbus & Southeast Indiana area I serve the Bloomington / Bedford area I serve the Terre Haute area I serve the Evansville area I serve the South Central Indiana (Louisville Metro) area Mediator Liability Insurance Carrier:* Mediator Liability Insurance Carrier is Required Policy or Endorsement #:* Policy or Endorsement # is Required Single Claim / Aggregate Amount (Minimum amount $100,000 / $300,000):* Single Claim / Aggregate Amount (Minimum amount $100,000 / $300,000) is Required Policy Expiration Date:* Policy Expiration Date is Required I have read and agree to the terms of the Mediator Referral Agreement* I serve the following areas:* Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger No val Please fix the errors above